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Tirelli et al. Mini-invasive Surg 2021;5:15 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.04

Case Report Open Access

Laparoscopic cholecystectomy with indocyanine

green fluorescence in patient with situs inversus
totalis

Flavio Tirelli, Michele Grieco, Alberto Biondi, Francesco Belia, Roberto Persiani

Department of General Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma - Università Cattolica del Sacro
Cuore, Rome 00168, Italy.
Correspondence to: Flavio Tirelli, MD, Department of General Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS,
Roma - Università Cattolica del Sacro Cuore. L.go A. Gemelli 8, Rome 00168, Italy. E-mail: tirelliflavio@gmail.com
How to cite this article: Tirelli F, Grieco M, Biondi A, Belia F, Persiani R. Laparoscopic cholecystectomy with indocyanine green
fluorescence in patient with situs inversus totalis. Mini-invasive Surg 2021;5:15. https://dx.doi.org/10.20517/2574-1225.2021.04

Received: 13 Jan 2021 First Decision: 10 Feb 2021 Revised: 22 Feb 2021 Accepted: 8 Mar 2021 Available online: 8 Apr 2021
Academic Editor: Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Situs Viscerum Inversus (SVI) is a rare autosomal recessive disease. Because of this particular anatomy, it could be
challenging for the surgeon to perform any abdominal procedure, including laparoscopic cholecystectomy. In these
situations, indocyanine green fluorescence cholangiography can be essential. A 29-year-old female with
documented situs viscerum inversus totalis underwent laparoscopic cholecystectomy with a four-trocar technique.
Switching the vision to the near-infrared camera, which elicited the indocyanine green molecules, the surgeon
could easily identify the common bile duct and the cystic duct. Switching back to the normal vision, the operator
completed the dissection. The described procedure is still challenging due to the “mirror effect” and the uncommon
position of the surgical instruments, especially for right-handed surgeons. Indocyanine green fluorescence
angiography can help the surgeon identify the structures in cases of non-regular anatomy such as this.

Keywords: Situs inversus totalis, indocyanine green fluorescence, cholecystectomy

INTRODUCTION
Situs Viscerum Inversus (SVI) is a rare autosomal recessive condition which affects from 1:10,000 to
[1]
1:20,000 live births . Kartagener’s syndrome takes place when situs inversus, chronic sinusitis, and
bronchiectasis occur together. Two variants are described: situs viscerum inversus partialis (involves
thoracic or abdominal organs alone) and situs viscerum inversus totalis (involves both thoracic and

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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